Quiz 1 Flashcards
Clinical reasoning can be impaired by:
Fragmentation of interpretation, Overreliance on classical interpretations, Less adequate knowledge
T/F experience is a safeguard against judgement errors
F
Voytovich and Rippey studied errors in what four categories?
Wrong synthesis (data contradiction), Omission (ignoring a clue), Inadequate synthesis (conclusion not completely supported by data), and premature closure
What is anchoring?
Tendency to retain hypothesis in spite of subsequent information
What is countertransference?
Fears of harming the patient, loss of control, and performance anxiety
Engler suggests that data-gathering requires what?
Communication and rapport with the client
What are some common problems of history-taking?
Omission of probing questions, Leading questions, Complex vocabulary, Not allowing enough time for the patient to speak, ignoring silence, and missing non-verbal signs
T/F Leavitt et al. shows back pain malingering is not strongly tied to workers’ compensation
T
Pain is a _____ not a diagnosis
Symptom
What % of back pain originates from musculoskeletal problems?
75-85%
10% of back pain orignate form ______ _______.
Unknown etiology
What % of the population suffers from LBP at some point?
50-80%
What % of back pain reoccurs?
30-70%
What portion of the vertebra bears most compressive loads?
Anterior
What portion of the annulus is innervated?
The outer half
What are the soft tissue components of the motion unit supplied by?
The sinu-vertebral nerve
Large afferent fibers transmit what?
Mechanoreception
Where do the large afferent fibers travel?
The dorsal horn -> substantia gelatinosa -> dorsal columns -> medial lemnisucs -> VPL thalamus -> post-central gyrus
What do small afferent fibers carry?
Nociception
Where do the small afferent fibers travel?
The tract of Lissauer -> dorsal horn -> anterior white commisure -> anterolateral tract -> VPL and VPM thalamus -> limbics, hypothalamus, medullary RF
C fiber stimulation causes?
Hyperpolarization of the substantia gelatinosa inhibitory interneurons
What does A-beta fiber stimulation cause?
Depolarization of the inhibitory interneurons
What cell type is an inhibitory interneuron?
T-cells
What substances produce an endogenous analgesic effect?
Endogenous opiates and enkephalins
Soft tissue irritation causes cell membrane breakdown and the formation of what substances?
prostaglandins, thromboxane, monohydroxy fatty acids, and leukotrienes
What 3 reactions determine whether a person finds a stimulus painful?
Neurologic, Biomechanic, and Emotional reaction
How many persons with low back pain are functioning again within a week?
75%
What is the timeline for acute and chronic pain formation?
Acute 0-1 week
Subacute 0-7 weeks
Chronic 7+ weeks
Fatigue, anxiety, and lack of activity increase with what?
Chronic pain
What factors correlate with the ability to return to work?
Length of sickness, absence period, need for analgesics, attitude to the problem, cervical and lumbar pain
What type of strength reduces pain?
isokinetic extensor strength
What is the most common psychological condition seen in chronic pain?
Depression/Intermittent depressive disorders
What pain is associated with worse coping mechanisms, myofascial or low back pain?
LBP
What types of dermotogenous pains are there?
Fast and Slow
Describe dermatogenous pain.
Sharp, lancinating, and clearly localized
What part of the motion unit is the source of most pain?
DRG or dorsal root
Where do most disk herniation occur?
L4-5 or L5-S1
Which side and disk has a greater propensity for injury?
L4-5 on the right side
What structure makes posterolateral disc (lumbar) protrusions more likely?
PLL (Tapers at the bottom)
Rank positions of disk pressure from least to greatest.
Supine -> standing -> sitting -> forward flexion + standing or sitting
What is another name for a medial disc protrusion?
Axillary
If a disk bulge irritates the apophysis, what type of motion produces pain?
Any motion
What structure are involved in scleratogenous pain?
Periosteum, joint capsule, subchondral bone, tendon, ligaments, articular cartilage, and synovium
What scleratogenous structures are most sensitive to pain?
Joint capsules and periosteum
Describe scleratogenous pain
Dull and vague at rest and more intense with activity
What types of symptoms often accompany scleratogenous pain?
Autonomic; pallor, sweating, nausea, low blood pressure
What is myotogenous pain?
Deep muscle pain
Describe muscle pain
Subtle at rest and aggravated by movement of said muscle group
What might muscle spasm become?
Trigger points
Where can trigger points occur?
Muscle, fascia, ligaments, pericapsular tissue and tendons
What types of trigger points are there?
Acute and latent
What are potential treatments for trigger points?
Local injection, massage, exercise, stretching, vapo-coolants, ischemic compression, ice massage, TENS, periosteal therapy, heat, and ultrasound
What are primary sensory modalities?
Pain, Temperature, Light touch, Position, and Vibration
What are secondary sensory modalities?
Higher cortical integration (parietal lobe), i.e. two point discrimination, awareness, graphesthesia, stereognosis
What do thoracic dermatomes tend to follow?
Intercostal nerves
T/F Thoracic dermatomes are easily distinguishable
False, they are difficult to separate
What lumbar discs are unusual to have lesions in?
L1-L2; L2-L3
Does proprioception ascend the contralateral or ipsilateral side of origin?
Ipsilateral
What is lost early in peripheral neuropathy?
Vibratory sensation
What levels may be involved in a large protrusion?
Anything below the level of disc protrusion
What is integrated to control posture?
Vestibular, Visual, and Proprioception
Most muscles are in what state?
Semi-contracted
L3-L4 motion unit pathology may lead to atrophy of what?
Quadriceps
L4-L5 motion unit pathology may lead to atrophy of
Anterior Tibial muscles
L5-S1 motion unit pathology may lead to atrophy of
Gastrocnemius and Soleus muscles
Deep tendon reflex is contingent on the function of what structures?
Muscle spindle, afferent nerves, DRG, efferent pathway, peripheral nerves
Does a DTR perform better or worse in the cold?
Worse
Protective reflex of paravertebral muscles reduces what motion?
Flexion
Organic pain is likely to be associated with what?
Lumbar kyphosis
What is often the result of osteoporotic vertebral compression?
Thoracic kyphosis
Asymmetric paravertebral muscle spasm may lead to what in a patient with disk herniation?
Scoliotic postures
What does the osteopathic evaluation of manipulative lesions mnemonic A.R.T stand for?
A - Asymmetry
R - RoM
T - Tissue/texture abnormalities
T or F: If one sagittal curve of the spine is increased, the other curves will increase
T
